三维适形放疗同步化疗治疗晚期非小细胞肺癌45例临床疗效观察

Clinical efficacy of three-dimensional conformal radiotherapy with concurrent chemotherapy in the treatment of advanced non-small cell lung cancer

目的观察三维适形放疗(3DCRT)同步化疗对晚期非小细胞肺癌(NSCLC)的临床疗效和不良反应。方法选取2008年1月至2010年7月治疗的90例晚期NSCLC患者为研究对象,按照治疗方式不同分为观察组和对照组各45例,对照组采用三维适形放疗,观察组采用三维适形放疗联合化疗,比较两组患者近期、远期疗效及不良反应。结果治疗结束后观察组治疗有效率(CR+PR)明显高于对照组(P<0.05);对照组1年内局部区域控制明显低于观察组(P<0.05),但两组患者的2年局控率差异无统计学意义;对照组1年和2年的远处转移率明显高于观察组(P<0.05)。两组患者均未出现4级的严重不良反应,观察组胃肠道反应和血液系统反应较对照组更为多见,包括恶心、呕吐、腹泻、肝功能受损以及血红蛋白、白细胞、血小板降低等(P<0.05);两组患者放射性食管炎和肺炎差异无统计学意义(P>0.05)。结论 3DCRT同步长春瑞滨化疗可显著提高NSCLC患者的近期疗效、局部控制率及降低远期转移率,治疗期间有轻、中度的胃肠道及血液系统不良反应发生,但均可耐受。

Objective To evaluate the clinical efficacy and toxicity of three-dimensional conformal radio-therapy （3D-CRT） with concurrent chemotherapy in the treatment of advanced non-small cell lung cancer （NSCLC）. Methods Ninety patients with NSCLC were selected and divided into two groups. Patients in the observation group （n=45） received 3D-CRT with concurrent chemotherapy, while those in the control group （n=45） received 3D-CRT. Comparison was made between two groups in the aspects of clinical efficacy and toxicity. Results The response rate （complete remission and partial remission） was significantly higher in the observation group than the control group （P〈0.05）. The 1-year disease progression free rate was significantly lower in the control group than the observation group, but the 2-year disease progression free rate showed no statistically significant differece between two groups. The l-year and 2-year distant metastasis rates were significant higher in the control group than the observation group （P〈0.05）. No grade 4 adverse reactions were observed. The toxicities of the observation group were more than those of the control group, especially in the aspect of digestive system and hematological system, including nausea, vomit-ing, diarrhea, liver function impairment, as well as decreased hemoglobin, white blood cells and platelets. Radia-tion-induced pneumonitis and radiation induced esophagitis showed no statistically significant difference between the two groups （P〉0.05）. Conclusion 3D-CRT with concurrent chemotherapy can significantly improve the clinical effi-cacy, and decrease distant metastasis rates and disease progression free rate. The toxicities were tolerable.